護理師準備給予心衰竭病人毛地黃(Digoxin)。下列哪些情況護理師應暫停給藥?(選所有適合的)
A nurse is administering a dose of digoxin to a patient with heart failure. Which findings require the nurse to hold the medication? (Select all that apply.)
- AApical heart rate of 52 beats/min✓ 正解心尖心率 52 次/分
- BSerum potassium level of 3.2 mEq/L✓ 正解血清鉀濃度 3.2 mEq/L
- CPatient reports seeing yellow halos around lights✓ 正解病人主訴看燈光周圍有黃色光暈
- DBlood pressure of 110/70 mmHg血壓 110/70 mmHg
- ESerum digoxin level of 1.2 ng/mL血清毛地黃濃度 1.2 ng/mL
毛地黃(Digoxin)具有窄治療指數(Narrow therapeutic index)。護理師給藥前必須確認病人有無中毒徵兆:心跳過慢(小於 60 bpm,心肌抑制)、低血鉀(增加毛地黃對心肌的結合力,加重毒性)、以及典型的視覺變化(如黃綠光暈)。若出現上述任一情況,應暫停給藥並通知醫師,以防發生嚴重心律不整。
Digoxin has a narrow therapeutic index. Before administration, the nurse must check for signs of toxicity: bradycardia (less than 60 bpm, indicating myocardial suppression), hypokalemia (which increases digoxin binding to myocardium and worsens toxicity), and characteristic visual disturbances such as yellow-green halos. If any of these findings is present, the dose should be held and the physician notified to prevent serious dysrhythmias.
美國臨床護理中,給予毛地黃前必須聽診心尖脈(Apical pulse)滿一分鐘,這是標準程序(Standard of care)。